90960

Dialysis services, 4 or more physician visits per month (20 years or older)

Code 90960. Medicare covered 1,124,753 of these. Here is what providers billed and what Medicare allowed, state by state.

$773.20Billed, national avg
$347.57Medicare allowed
2.2xBilled vs allowed
5.9xHighest vs lowest state

Providers in Alaska billed the most for this, at $1,753.20. In Northern Mariana Islands the average was $298.11. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$1,753.20$441.934.0x2,852
Wisconsin$1,391.47$327.804.2x16,719
Vermont$1,359.25$330.934.1x503
New Hampshire$1,085.35$353.263.1x4,945
Minnesota$1,067.13$336.103.2x6,744
North Dakota$1,045.98$338.313.1x2,938
Tennessee$943.22$324.352.9x21,529
Wyoming$934.81$344.102.7x549
Massachusetts$928.95$361.792.6x19,892
Connecticut$917.17$365.062.5x10,455
Oregon$907.87$344.312.6x8,038
Nevada$882.13$344.952.6x12,701
New York$877.59$371.262.4x76,417
Iowa$862.19$328.072.6x5,924
New Mexico$840.75$348.422.4x8,479
Colorado$831.62$355.182.3x8,896
Mississippi$827.59$321.522.6x19,443
Illinois$819.13$352.322.3x50,613
Washington$784.60$348.822.2x10,188
Utah$783.27$335.742.3x5,181
Nebraska$774.90$327.612.4x3,187
Missouri$774.18$334.402.3x18,525
Montana$772.81$343.702.2x2,310
North Carolina$770.52$333.902.3x40,079
Texas$766.35$337.142.3x108,154
Georgia$762.20$338.742.3x41,824
Maryland$758.60$361.112.1x37,704
California$748.40$365.852.0x156,158
Rhode Island$740.22$345.402.1x3,867
Arizona$738.50$332.892.2x18,784
Michigan$736.64$342.712.1x33,922
New Jersey$735.46$370.042.0x41,399
Florida$731.39$348.112.1x70,519
South Dakota$725.11$328.762.2x2,882
Kansas$720.43$335.812.1x7,570
District of Columbia$720.15$387.321.9x5,391
Virginia$712.35$344.192.1x30,290
Hawaii$709.03$338.792.1x8,277
South Carolina$699.44$334.772.1x23,707
West Virginia$690.14$335.592.1x4,070
Ohio$684.06$333.992.0x25,607
Maine$681.05$339.412.0x3,600
Indiana$679.69$331.712.0x20,307
Oklahoma$672.28$327.312.1x9,337
Delaware$651.43$343.171.9x6,389
Pennsylvania$640.50$345.091.9x42,900
Kentucky$633.99$333.781.9x13,133
Louisiana$627.80$331.831.9x16,912
Idaho$584.58$329.201.8x3,311
Arkansas$582.95$320.011.8x9,293
Alabama$565.75$321.901.8x16,153
Virgin Islands$537.85$342.491.6x1,210
Guam$367.74$339.041.1x2,650
Puerto Rico$357.22$329.431.1x2,055
Northern Mariana Islands$298.11$280.721.1x117

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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